Future of Nursing Report: Broader Scope in COVID Should Stay

Marcia Frellick

May 11, 2021

The new Future of Nursing report released today recommends that the broader scope of practice many states allowed for nurses during the pandemic should be made permanent.

That recommendation is one of dozens the authors detailed in the National Academy of Medicine's "The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity."

"By 2022, all state and federal policy changes in response to the COVID-19 pandemic that expanded scope of practice should be made permanent, along with telehealth eligibility, insurance coverage, and equal payment for services provided by nurses," the report states.

Prior to the pandemic, only 23 states and the District of Columbia allowed nurse practitioners to practice to their full license, including prescribing, diagnosing, and managing treatments without a physician present.

Under full practice authority, access to primary care and quality of care has improved, the report states.

Susan C. Reinhard, RN, PhD, senior vice president and director of the AARP Public Policy Institute, serves as the chief strategist for the Center to Champion Nursing in America. She told Medscape Medical News that even though the 23 states allow full practice for NPs, those states make up only 25% of the patient population.

"Seventy-five percent of our population still lack direct access to nurse practitioners and other advanced practice nurses who can practice to their fullest extent," she said.

More Public Health, School Nurses

In further work toward health equity, the report also calls for local, state, and federal governments to prioritize hiring more school and public health nurses.

Marshall Chin, MD, MPH, a professor of healthcare ethics at the University of Chicago, Chicago, Illinois, told Medscape Medical News, "If we're going to be patient-centered, we need to do a better job of meeting patients where they are."

School nurses, for instance, have a sense of a student's home life as opposed to the view in the clinical setting, said Chin, who served on the committee that wrote the report. However, 25% of schools do not have a school nurse, and school nursing remains "woefully underfunded," Chin continued, especially in schools serving children in low-income households.

Knowledge of home life is a window into the social determinants of health that include whether a family has enough to eat or transportation to medical appointments and pharmacies, for instance.

This report should resonate with clinicians of all types, Chin emphasized.

"If we're going to get to the best possible outcomes for all our patients, we need to address their medical issues as well as social issues and address issues for our individual patients as well as the systemic, structural factors that impact healthcare," Chin said.

Some of the recommendations came with deadlines as early as the end of this year.

For example, by the end of 2021, the report authors call for all national nursing organizations — led by the Tri-Council for Nursing and the Council of Public Health Nursing Organizations — to begin developing a shared blueprint for addressing social determinants of health and achieving health equity.

Education With a Community Health Focus

The authors of the report point out that nursing education has long centered on hospital-based care, rather than care in community settings, schools, workplaces, and home healthcare.

Nursing schools should increase coursework and hands-on learning in primary care, and in federally qualified health centers, rural health clinics, and Indian Health Service sites, the report recommends.

Reinhard said her own nursing education included going to settings such as Alcoholics Anonymous meetings, prisons, and mental health institutions.

"People don't live in hospitals," she noted. "They live in homes and communities. We have to go to them."

She said that this report, just as the previous report 10 years ago, "The Future of Nursing: Leading Change, Advancing Health" will drive real change in nursing.

Since the previous report — which focused heavily on increasing the number of nurses with advanced degrees — "there has been a 236% increase of nurses going from their associate degree to baccalaureate degrees from 2009-2019," she said.

Chin and Reinhard have disclosed relevant financial relationships.

National Academies of Sciences, Engineering, and Medicine. 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News and Nurse.com and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick

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